Provider Demographics
NPI:1215224548
Name:LANGE, SARA PAIGE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:PAIGE
Last Name:LANGE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BRIER LN
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-2616
Mailing Address - Country:US
Mailing Address - Phone:917-863-8517
Mailing Address - Fax:
Practice Address - Street 1:333 E 135TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-4301
Practice Address - Country:US
Practice Address - Phone:917-863-8517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021108-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist